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Beyond adoption : a new framework for theorizing and evaluating nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability of health and care technologies
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Greenhalgh, Trisha, Wherton, Joseph, Papoutsi, Chrysanthi, Lynch, Jennifer, Hughes, Gemma, A'Court, Christine, Hinder, Susan, Fahy, Nick, Procter, Rob and Shaw, Sara (2017) Beyond adoption : a new framework for theorizing and evaluating nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability of health and care technologies. Journal of Medical Internet Research, 19 (11). e367. doi:10.2196/jmir.8775
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Official URL: http://doi.org/10.2196/jmir.8775
Abstract
Background
Many promising technological innovations in health and social care are characterized by nonadoption or abandonment by individuals or by failed attempts to scale up locally, spread distantly, or sustain the innovation long term at the organization or system level.
Objective
Our objective was to produce an evidence-based, theory-informed, and pragmatic framework to help predict and evaluate the success of a technology-supported health or social care program.
Methods
The study had 2 parallel components: (1) secondary research (hermeneutic systematic review) to identify key domains, and (2) empirical case studies of technology implementation to explore, test, and refine these domains. We studied 6 technology-supported programs—video outpatient consultations, global positioning system tracking for cognitive impairment, pendant alarm services, remote biomarker monitoring for heart failure, care organizing software, and integrated case management via data sharing—using longitudinal ethnography and action research for up to 3 years across more than 20 organizations. Data were collected at micro level (individual technology users), meso level (organizational processes and systems), and macro level (national policy and wider context). Analysis and synthesis was aided by sociotechnically informed theories of individual, organizational, and system change. The draft framework was shared with colleagues who were introducing or evaluating other technology-supported health or care programs and refined in response to feedback.
Results
The literature review identified 28 previous technology implementation frameworks, of which 14 had taken a dynamic systems approach (including 2 integrative reviews of previous work). Our empirical dataset consisted of over 400 hours of ethnographic observation, 165 semistructured interviews, and 200 documents. The final nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework included questions in 7 domains: the condition or illness, the technology, the value proposition, the adopter system (comprising professional staff, patient, and lay caregivers), the organization(s), the wider (institutional and societal) context, and the interaction and mutual adaptation between all these domains over time. Our empirical case studies raised a variety of challenges across all 7 domains, each classified as simple (straightforward, predictable, few components), complicated (multiple interacting components or issues), or complex (dynamic, unpredictable, not easily disaggregated into constituent components). Programs characterized by complicatedness proved difficult but not impossible to implement. Those characterized by complexity in multiple NASSS domains rarely, if ever, became mainstreamed. The framework showed promise when applied (both prospectively and retrospectively) to other programs.
| Item Type: | Journal Article | |||||||||||||||
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| Subjects: | R Medicine > R Medicine (General) T Technology > T Technology (General) |
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| Divisions: | Faculty of Science, Engineering and Medicine > Science > Computer Science | |||||||||||||||
| Library of Congress Subject Headings (LCSH): | Medical care -- Technological innovations, Diffusion of innovations, Organizational change, Medical records -- Data processing, Medical innovations, Hospitals -- Outpatient services, Mild cognitive impairment, Monitor alarms (Medicine), Biochemical markers | |||||||||||||||
| Journal or Publication Title: | Journal of Medical Internet Research | |||||||||||||||
| Publisher: | Journal of Medical Internet Research | |||||||||||||||
| ISSN: | 1438-8871 | |||||||||||||||
| Official Date: | November 2017 | |||||||||||||||
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| Volume: | 19 | |||||||||||||||
| Number: | 11 | |||||||||||||||
| Article Number: | e367 | |||||||||||||||
| DOI: | 10.2196/jmir.8775 | |||||||||||||||
| Status: | Peer Reviewed | |||||||||||||||
| Publication Status: | Published | |||||||||||||||
| Access rights to Published version: | Restricted or Subscription Access | |||||||||||||||
| RIOXX Funder/Project Grant: |
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